Archive for June, 2018

Ladies, If You Leak When You Exercise

June 30, 2018

Andrew Siegel MD  6/30/18

Exercise is of vital importance to physical and psychological health, reduces risk for diabetes, cardiovascular disease and cancer, is a great stress reducer and improves muscle strength, endurance, coordination and balance. It is an important factor in maintaining a healthy weight, decreasing body fat, increasing longevity and decreasing mortality. All good!girl-woman-sport-photographer-train-recreation-1165198-pxhere.com (1).jpg

image above, Creative Commons

Urinary incontinence is an annoying condition that women experience much more commonly than do men.  One of the main types is leakage with physical activities and exercise, a.k.a. stress urinary incontinence (SUI). When a woman suffers from SUI it often acts as a barrier to exercising because no one wants to be put in the embarrassing and inconvenient situation of wetting themselves every time they jump, bounce or move vigorously. Some women adapt by modifying the types of exercise that they participate in, while others give up completely on exercising, an omission that can contribute to poor physical and psychological health, a greater risk for medical issues, weight gain, etc.

What physical activities cause leakage?

The most common exercises that provoke SUI are high impact, vertical deceleration activities in which there is repeated contact with a hard surface with both feet simultaneously, e.g. skipping, trampoline, jumping jacks, jumping rope, running and jogging.

Other physical activities that commonly provoke SUI are exercises that combine dynamic abdominal and pelvic movements, e.g., burpees, squats, sit ups and weight bearing exercises, e.g., weighted squats, overhead kettle bell swings, etc.  The classic weight lifting style exercises are occasional triggers of SUI.

Activities that cause SUI (in order of those most likely to provoke the SUI)

  1. Skipping
  2. Trampoline
  3. Jumping jacks
  4. Running
  5. Jogging
  6. Box jumps
  7. Burpees
  8. Squats
  9. Sit ups
  10. Weighted squats
  11. Kettle bell swings
  12. Dead lifts
  13. Push ups
  14. Wall balls
  15. Shoulder press
  16. Clean and jerk
  17. Snatch
  18. Bench press
  19. Rowing

 So, what to do?

Many women figure out the means to improve or diminish the problem.  Common sense measures include urinating immediately before exercising and if possible taking washroom breaks during the activity (not always possible and inconvenient).  Even so, most women do not empty the bladder 100%, so if 1-2 ounces remain after emptying, there is still plenty of urine to potentially leak.  Other adaptive measures are fluid restriction (not particularly healthy before vigorous activity, risking dehydration).  Wearing a protective pad or incontinence tampon is certainly a way around the problem (although not ideal).  Another strategy is to modify one’s exercise program, such as reducing the duration, frequency or intensity of the activity.  Avoiding high impact exercises entirely and substituting them with activities that involve less impact is another possibility. However, these are adaptive and coping mechanisms and not real solutions.

There is a better solution

Urologists–particularly those like myself who have expertise in female pelvic medicine–can help manage the condition of stress urinary incontinence.  First line treatment is  Kegel pelvic floor exercises that—when done properly (as they are often not) with the right program—can often significantly improve the situation.

New video on pelvic floor exercises.

If a concerted effort at a Kegel program fails to sufficiently improve the situation, a 30-minute outpatient procedure called a mid-urethral sling is a highly effective means of treating the exercise incontinence.

Bottom Line: Physical activities most likely to induce urinary leakage are high impact exercises including skipping, trampoline, jumping jacks, jump rope and jogging.  Coping mechanisms and adaptive behaviors include fluid restriction (not healthy before exercise), urinating before activities (reasonable), taking breaks from exercise to urinate (inconvenient), pads (ugh), dialing down the intensity of exercising, modifying type of exercise or complete avoidance of exercising (undesirable).  If coping and adaptive behaviors are not effective, consider seeing a urologist who focuses on incontinence.  The goal of treatment is to be able to return to the physical activities that you enjoy without the fear of urinary leakage.   

Excellent resource: Urinary leakage during exercise: problematic activities, adaptive behaviors, and interest in treatment for physically active Canadian women: E Brennand, E Ruiz-Mirazo, S Tang, S Kim-Fine, Int Urogynecol J (2018)29: 497-503

Wishing you the best of health and a happy 4th of July holiday!

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

 

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Noctiva: A New Treatment for Annoying Nighttime Peeing

June 23, 2018

Andrew Siegel MD    6/23/18

bottles-8MM[1]There is compelling medical evidence that a good night’s sleep is of vital importance for one’s health. We recognize this intuitively when we compare how we feel after a night of sleeping well as opposed to a night of sleep deprivation, but it goes way beyond mere fatigue.  Sleeping well is a key component to cognitive and physical fitness as well as overall health, equally important to diet and exercise. Aside from daytime fatigue, weight gain because of altered eating patterns, and increased risk of traffic accidents and fall-related nighttime injuries, sleep deprivation has been associated with an assortment of medical problems that negatively affect quality and quantity of life.  

Although there are many reasons for failing to obtain sufficient sleep, one such cause is interrupted sleep from the need to frequently empty one’s bladder. This can be disruptive to achieving a good night’s sleep, with many nighttime voiders unable to get back to sleep after urinating. Today’s entry reviews a new medication that can help sleep-disruptive nighttime urinating when it is caused by overproduction of urine, a causal factor in over 80% of cases of nighttime urination.

Nighttime urination—nocturia in medical speak—is a complex condition that aside from affecting quality of sleep and quality of life can be a symptom of underlying medical issues, e.g., diabetes, obstructive sleep apnea and cardiovascular issues. It is common in both women and men, tends to increase with aging, and its underlying basis is often multifactorial.  If it occurs once or twice a night and is not too bothersome and one can readily get back to sleep, it is no big deal.  However, if it occurs more than twice a night and is sleep-disruptive, it may be time to consider a means of improving the situation. Importantly, although nocturia is typically a complaint that drives patients to urologists, most of the time the nocturia is NOT urological in origin.

A simple test to help assess nocturia is a 24-hour voiding diary, which requires a pen and paper, a watch or clock and a measuring cup. The time at which urination occurs and the volume of each urination are recorded. Typical bladder capacity is 10–12 ounces with 4–6 urinations per 24 hours. Such a diary will help differentiate between those with a reduced bladder capacity, those who produce lots of urine only while sleeping, and those who produce lots of urine both day and night.

Reduced bladder capacity is often a sign of urological issues including overactive bladder, benign prostate enlargement, neurological diseases affecting the bladder, and loss of elasticity of the bladder as may occur with pelvic radiation.

Those who produce lots of urine only while sleeping are commonly found to have the following causes: increased fluid intake in the evening, obstructive sleep apnea, edematous states such as congestive heart failure, and failure to produce sufficient quantity of a hormone that regulates urine production.

Drinking a few cups of coffee or tea after dinner or a few beers before bedtime will cause nighttime urination and has an obvious solution. Obstructive sleep apnea is a under-appreciated and common cause of full-volume nighttime urination that when treated with CPAP (continuous positive airway pressure) or other means will significantly reduce the nocturia. Edema is fluid within the tissues–-typically the ankles and legs–that tends to accumulate aided by gravity over the course of the day. Upon assuming the lying-down position when sleeping, the legs are relatively elevated as opposed to standing and this tissue fluid returns into circulation, causing the kidneys to increase urine production. In general, those with peripheral edema go to sleep with ankles and legs engorged with edema fluid and wake up with thinner legs, as the return of some of the fluid to the circulation and the subsequent increased urination rids them of this. Another possibility is an abnormality in the nocturnal secretion of anti-diuretic hormoneThis pituitary hormone causes the kidneys to concentrate urine and pull water back into the circulation; nocturia may occur because of an age associated decline in its secretion while sleeping.

Those who produce lots of urine both day and night often have overzealous fluid intake, diabetes mellitus or diabetes insipidus, or are on certain medications (e.g., lithium) that can cause the problem.

Noctiva (Desmopressin) to treat nocturnal excessive urine production

One of the most common reasons for nocturia is excessive nighttime urine production, defined as nighttime urine volume exceeding 1/3 of the 24-hour urine production.  If this is demonstrated on the voiding diary, you may be a candidate for this anti-diuretic medication that works by decreasing nocturnal urinary production.

Desmopressin is a synthetic version of anti-diuretic hormone. The function of this hormone is to put the “brakes” on the kidneys so that the kidneys do not allow excessive loss of body water, which could be detrimental to one’s health and lead to severe dehydration. For years, desmopressin has been used for children who are bed wetters.

Noctiva (Desmopressin) nasal spray is a new formulation of intranasal desmopressin for those who have full-bladder volume nocturia two or more times.  It is a modification of desmopressin that is designed to enhance absorption from the nasal lining, available in doses of 0.83 and 1.66 microgram.  One spray in either nostril is used about 30 minutes prior to sleep.

The absorption of this product is enhanced as compared to that of the oral version (8% vs. 0.3%), which means more consistent dosing and rapid absorption and elimination allowing more rapid onset and less prolonged drug activity.  It is well tolerated with the most common side effect low levels of sodium and other side effects including nasal irritation, nasal congestion, nosebleeds, sneezing, and high blood pressure.  The drug cannot be used in the face of excessive fluid intake, low serum sodium, steroids or loop diuretic use, heart failure, uncontrolled high blood pressure, poor kidney function, and with illnesses causing fluid and electrolyte imbalances. Sodium levels need to be monitored periodically.

Bottom Line: Nocturnal urinary frequency should be investigated to determine its cause, which may in fact be related to conditions other than urinary tract issues.  Nighttime urination is not only bothersome but may also pose real health risks as chronically disturbed sleep can lead to a host of collateral wellness issues. Noctiva is a new addition to the armamentarium to combat nighttime urination when it is due to excessive nocturnal urinary production.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

New video on female pelvic floor exercises:  Learn about your pelvic floor

Blood in the Urine in Patients on Anticoagulants

June 16, 2018

Andrew Siegel MD  6/16/2018

klee-3424581_1920

TY, Pixabay, for image above

Many people take blood thinners to prevent clotting complications that may occur as a result of cardiac arrhythmias—particularly atrial fibrillation, cardiac valvular disease; cardiomyopathy, mechanical heart valves, as well as for treatment or prevention of venous clotting and pulmonary embolism. Visible urinary bleeding is not uncommon in patients on anticoagulants, especially under the circumstance of being “over”-anti-coagulated.  Anticoagulants per se do not usually cause urinary bleeding, but if there is an underlying urinary tract abnormality they can provoke and perpetuate the bleeding.  Thus the importance of doing an evaluation to search for an underlying cause of the urinary tract bleeding.

Commonly used anticoagulants (blood thinners)

  • Fragmin (dalteparin)
  • Lovenox (enoxaparin)
  • Heparin
  • Coumadin (warfarin)
  • Eliquis (apixaban)
  • Pradaxa (dabigatran)
  • Xarelto (rivaroxaban)
  • Plavix (clopidogrel)
  • Brilinta (ticagrelor)

Hematuria

Medical speak for blood in the urine is hematuria.  When blood can be seen it is called gross hematuria, although I prefer the term visible hematuria. Visible hematuria may cause red urine if the bleeding is fresh or tea or cola-colored urine if the bleeding is old. Sometimes hematuria is accompanied by blood clots. At times hematuria is only evident by seeing bloodstains on one’s underwear or appearing on toilet tissue after wiping.

Most hematuria is painless. When there is pain associated with hematuria, it is often a symptom of a kidney stone or urinary infection. Like a nosebleed, hematuria can be a non-significant problem due to a ruptured blood vessel, or alternatively, it can be due to a serious issue that mandates treatment, such as a kidney or bladder cancer, which are  two of the most serious causes of hematuria. Those who use or who have used tobacco and have hematuria have a much higher risk of bladder  and kidney cancer than non-tobacco users. The most common cause of hematuria in men is benign prostate enlargement (as the prostate grows, so does the blood supply) and the most common cause in women is a urinary infection.

Hematuria can occur after vigorous exercise, particularly in people who have bladder stones or an underlying structural abnormality of the urinary tract. Hematuria can be a side effect occurring many years following pelvic radiation to treat cancers of the bladder, prostate, rectum, uterus, cervix, etc.

What to do If you experience urinary tract bleeding while anti-coagulated:

  1. Inform your doctor who prescribed the anticoagulant and  ensure that you are on the appropriate dosage.
  2. If the bleeding is severe enough, it may be necessary to temporarily halt the use of the anticoagulant. Make sure this decision is discussed with the doctor who prescribed the anticoagulant.
  3. Restrict exertional activities and straining with bowel movements and any other activity that may exacerbate the bleeding.
  4. Step up your fluid intake to dilute the urine and promote passage of blood clots.
  5. See your urologist to be properly evaluated.

How hematuria is evaluated

Urine Cytology:  Pap smear of a specimen of urine that looks for abnormal cells.

Urine Culture: Lab test to see if a urinary infection is present.

Imaging Tests: Ultrasound, computerized tomography (CT), magnetic resonance imaging (MRI) and cystoscopy with contrast injected into the ureters to image the inner aspects of the upper urinary tract (retrograde studies) are all possibilities.

Cystoscopy: A visual inspection of the bladder with a narrow, flexible instrument performed on a video monitor with magnification.

Bottom Line:  Regardless of whether or not you are anti-coagulated, never ignore blood in urine, whether visible or microscopic (seen on a urinalysis test).  It may be “nothing” (not a sign of a serious illness) or may be “something” (a warning sign of a potentially life-threatening illness), so it is always beneficial to seek proper evaluation.  If you experience hematuria while anti-coagulated, do not assume that it is an expected consequence of the medication, since there may be serious underlying problems that are “provoked” or “unmasked” by the anticoagulant. Do not panic since the cause can usually be readily determined and treatment initiated; even if the precise cause cannot be pinpointed, serious underlying causes can be excluded.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

Cover

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

 

Try This First Before Seeing A Urologist

June 9, 2018

Andrew Siegel MD  6/9/2018

Picture1

Many suffer with urinary urgency and frequency, requiring repeated trips to the bathroom.  Although not serious or life-threatening, it is annoying and inconvenient.  After happening repeatedly, it can be become an ingrained habit that is difficult to break.  Concerns surface about sitting in traffic, traveling, seeing a Broadway show, getting the right seat on an airplane, etc.

 If you are dealing with an urgency/frequency issue, you may benefit from “bladder retraining.”  It is relatively simple, requires neither medication nor surgery, and can help you control when you urinate, how often you urinate and allow you to delay urinating. 

What happens under normal circumstances

As the bladder gradually fills, most people ignore the initial sense of urgency, continuing to go about their life and carrying on with their activities.  As the bladder continues to fill, they continue to tune out the sense of urgency until the point that it becomes compelling enough so that they are motivated to leave their activity and go to the bathroom to empty their bladder.

What happens to the frequent urinator

For one reason or another, the frequent urinator often becomes “hyper-vigilant” about their sense of urinary urgency.  For him or her, the bladder is “front burner” and not “back burner.”  This may be based on a previous physical bladder problem that gave rise to the hyper-focus, commonly a urinary infection. The frequent urinator often responds to the initial sense of urgency by acting upon it and heading to the bathroom to empty their bladder.  When this behavior is habitually repeated, it becomes a dysfunctional ingrained habit—the “new normal,” and again, a habit that is tough to break. The bottom line is that when there is excessive focus on the sensations arising from the bladder (or for that matter, any part of the body), one will be hyper-acutely aware of sensations that they normally are not cognizant of.

As another example of this, if you focus on the weight of your watch on your wrist or your ring on your finger, within a matter of minutes, their presence will start annoying you.  No good comes of when background becomes foreground!

A 24-hour bladder diary (log of urination recording time of urinating and the volume of each urination) is a simple but helpful tool in sorting out the different causes of urgency/frequency.  Since normal bladder capacity is about 12 ounces, if the diary shows frequent voids of full volumes, the problem is most likely related to excessive fluid intake (or rarely a kidney or hormonal problem that can cause excessive urinary production).  However, if the diary shows frequent voids of small volumes (e.g., 4 ounces), the problem can often be improved with bladder retraining. If the diary shows frequent voids of small volumes during the day, but full volume voids while sleeping or no voids while sleeping, it points to frequency on a psychological basis and also can often be improved with bladder retraining. It is important to know that frequent voiding of smaller volumes is not always a dysfunctional habit and may be on the basis of prostate or bladder issues that might require the services of your friendly urologist.  However, no harm can come from an initial attempt at bladder retraining.

Fixing it

The goal of bladder retraining is to break the dysfunctional habit and restore normal—or at least better—bladder functioning.  Bladder retraining can be challenging, yet rewarding, and requires a positive attitude and being willing, informed and engaged.

  1. FLUID AND CAFFEINE IN MODERATION

Urgency will often not occur until a “critical” urinary volume is reached, and by limiting fluid intake, it will take a longer time to achieve this volume. Try to sensibly restrict your fluid intake (without causing dehydration) in order to decrease the volume of urinary output. Caffeine (present in tea, coffee, colas, some energy drinks and chocolate) can increase urinary output and is a urinary irritant, so it is best to limit intake of these beverages/foods.  Additionally, many foods—particularly fruits and vegetables—have hidden water content, so moderation applies here as well.  It is important to try to consume most of your fluid intake before 7:00 PM to improve nighttime frequency.

  1. ASSESS MEDICATIONS

Diuretic medications (water pills) can contribute to frequency by design. If you are on a diuretic, it may be worthwhile to check with your medical doctor to see if it is possible to change to an alternative, non-diuretic medication. This will not always be feasible, but if it is, may substantially improve your frequency.

  1. AVOID BLADDER IRRITANTS

Irritants of the urinary bladder may be responsible for worsening your symptoms.  Consider eliminating or reducing one or more of the following irritants and then assessing whether your frequency improves:

Tobacco

Alcoholic beverages

Caffeinated beverages: coffee, tea, colas and other sodas and certain sport and energy drinks

Chocolate

Carbonated beverages

Tomatoes and tomato products

Citrus and citrus products: lemons, limes, oranges, grapefruits

Spicy foods

Sugar and artificial sweeteners

Vinegar

Acidic fruits: cantaloupe, cranberries, grapes, guava, peaches, pineapple, plums, strawberries

Dairy products

  1. URGENCY INHIBITION

The act of reacting to the first sense of urgency by running to the bathroom needs to be modified.  Stop in your tracks, sit, relax and breathe deeply. Pulse your pelvic floor muscles rhythmically to deploy your own natural reflex to resist and suppress urinary urgency (more about this below).

  1. INTERVAL TRAINING

Imposing a gradually increasing interval between urinations will help establish a more normal pattern of urination. If you are urinating small volumes on a frequent basis, your own sense of urgency is not providing you with accurate information about the status of your bladder fullness.  Urinating by the “clock” and not by your own sense of urgency will keep your voided volumes more appropriate. Voiding on a two-hour basis is usually effective as a starting point, although the specific timetable has to be tailored, based upon the bladder diary.  A gradual and progressive increase in the interval between voiding can be achieved by consciously delaying urinating.  A goal of an increase in the voiding interval by 15-30 minutes per week is desirable.  Eventually, a return to more acceptable voiding intervals is possible. The urgency inhibiting techniques mentioned above are helpful with this process.

  1. BOWEL REGULARITY

A rectum full of gas or fecal material can contribute to urinary difficulties. Because of the proximity of the rectum and bladder, a full rectum can put internal pressure on the bladder, resulting in worsening of urgency and frequency.

  1. PELVIC FLOOR MUSCLE TRAINING (PFMT)

The pelvic floor muscles (PFM) play a VITAL role in inhibiting urgency and frequency.  Voluntary rhythmic pulsing of the PFM can inhibit urgency and frequency and PFMT hones the inhibitory reflexes between the pelvic floor muscles and the bladder.

Initially, one must develop an awareness of the presence, location, and nature of the PFM and then train these muscles to increase their strength and tone.  These are not the muscles of the abdominal wall, thighs or buttocks.  A simple means of recognizing the PFM for a female is to insert a finger inside her vagina and squeeze the PFM until the vagina tightens around her finger.  Another means of identifying the PFM for either gender is to start urinating and when about half completed, to abruptly stop the stream. It is the PFM that allows one to do so.  When feeling the urge to urinate, rhythmic pulsing of the PFM–“snapping” the PFM several times—can diminish the urgency and delay a trip to the bathroom.

  1. LIFESTYLE MEASURES: HEALTHY WEIGHT, EXERCISE, TOBACCO CESSATION

The burden of excess pounds can worsen frequency by putting pressure on the urinary bladder, similar to the effect that excessive weight has on your knees. Even a modest weight loss may improve the situation.  Pursuing physical activities can help maintain general fitness and improve frequency. Lower impact exercises–yoga, Pilates, cycling, swimming, etc.–can best help alleviate pressure on the urinary bladder by boosting core muscle strength and tone and improving posture and alignment. The chemical constituents of tobacco constrict blood vessels, impair blood flow, decrease tissue oxygenation and promote inflammation, compromising the bladder, urethra and pelvic muscles.  By eliminating tobacco, symptoms can be improved.

Bottom Line: Bladder retraining can be an effective means of whipping your bladder (and your mind) into shape to help convert dysfunctional habits into more normal and appropriate voiding patterns.  This has the potential of helping many people. However, if the aforementioned strategies fail to improve your situation, you should have a basic urological evaluation, including a urinalysis (dipstick exam of the urine), a urine culture (test for urinary infection) if indicated, and determination of how much urine remains in your bladder immediately after emptying.  At times, tests such as cystoscopy (a visual inspection of the urethra and bladder with a narrow, flexible instrument) and urodynamics (sophisticated tests of bladder function) will need to be done as well. Urologists have the wherewithal to improve this situation and your quality of life.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD: PelvicRx

Female version in the works: Female PelvicRx

Little Tumors in the Kidney: Challenges and Solutions

June 2, 2018

Andrew Siegel MD    6/2/18

Years ago–prior to the advent of advanced means of imaging the abdomen–malignant growths of the kidney would manifest with symptoms.  The “classic triad” of symptoms and signs were pain, blood in the urine and a mass that could be felt on examination.  Nowadays, the vast majority of renal masses are asymptomatic, incidental (unexpected) findings picked up on imaging studies done for other issues. The widespread and liberal use of ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI) done for a variety of reasons not uncommonly result in the incidental finding of a small mass in the kidney, known as a small renal mass (SRM).  Urologists are the go-to doctors who manage renal masses, including SRMs, which can present challenges in term of how best to manage it.

small-kidney-tumor-right

SRM of right kidney on CT

 Evaluation

So, what to do when one is found to have a small mass in the kidney, often less than one inch (2.5 cm) in diameter?

A CT or MRI imaging study without and with contrast is recommended for the assessment of renal masses. The premise is that when a mass takes up contrast, it has a blood supply and is usually not a simple benign cyst containing fluid, but a solid mass that is considered malignant until proven otherwise.  Although these studies are capable of diagnosing and evaluating solid renal masses and distinguishing them from fluid-filled cysts, neither study is capable of distinguishing benign from malignant.

One possibility to address the shortcomings of CT and MRI is a CT-guided kidney biopsy.  It is an outpatient procedure performed by an interventional radiologist who obtains a tiny biopsy of the area of concern using CT guidance.  The biopsy is microscopically studied by a pathologist.  This can distinguish benign from malignant as well as provide tumor type and grade.  Such a biopsy can reduce unnecessary surgery for benign lesions and guide the selection of patients appropriate for monitoring and those who need to be treated.

Fact: About 20% of SRMs are potentially aggressive kidney cancers, 50% exhibit slow growth and are unlikely to ever be a problem, and 30% are benign.

Prognostic factors

Size is of significance, as larger masses have a higher risk of being malignant.  Mass size also predicts the possibility of spread, with a 2.4% risk in tumors under 3 cm versus 8.4% for tumors 3 – 4 cm. Another important factor is tumor growth rate, the average being 0.1 – 0.4 cm/year. Rapidly growing masses are at higher risk for progression and spread.

To treat or not

Active surveillance—careful interval imaging and follow-up with consideration for intervention if the situation merits a change—is a prudent means of management of the SRM in elderly patients, in those with significant medical problems who have a limited life expectancy, and those at high risk for surgery and surgical complications. Active surveillance is also an excellent option in patients who have a solitary kidney or significant kidney disease. Clinical studies have shown that management of SRMs with initial surveillance and delayed intervention does not compromise the success of the surgery or increase the risk of local spread or metastases.

On the other hand, a young, healthy patient with a long life expectancy merits definitive treatment. Typical treatment options are partial nephrectomy versus tumor ablation.  Partial nephrectomy is most often done via laparoscopy with robotic assistance and removes the mass with a margin of normal tissue, sparing the bulk of the kidney. An ultrasound probe is used to help the surgeon precisely image the tumor and its margins.

An alternative option is tumor ablation– the application of heat (radio-frequency) or cold (cryosurgery) directly into the SRM–in an effort to destroy the tumor while leaving the remaining kidney intact.  This can be performed percutaneously (using a needle placed through the skin without an incision) via CT imaging.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

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These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (the female version is in the works): PelvicRx